Linked tibial resection guide

ABSTRACT

An improved resection guide and method using same are disclosed. The guide is preferably utilized in resecting the tibia during either a single or double unicondylar type procedure. Preferably, the guide allows for linked resection of the tibia while also being capable of conforming to many different patient sizes. This may also allow for a more precise resection to be accomplished.

BACKGROUND OF THE INVENTION

The field of orthopedic surgery is a constantly evolving one. While thesame anatomical problems often occur in patients and require orthopedicprocedures, the apparatus and methods for performing the many differentsurgeries often change. Surgeons must keep up with the latest andgreatest technology in order to continue to better serve their patients.For instance, there exist many different procedures for alleviating painin, restoring normal movement to, and otherwise repairing the kneejoint. Whether traditional or minimally invasive, or full or partial,knee replacement surgery has become a common orthopedic procedure. Thepresent invention relates to an improved apparatus utilized in animproved method for performing one or two simultaneous unicondylar kneereplacement procedure(s).

A unicondylar procedure typically involves the replacement of only onecompartment of the knee joint, rather than the entire joint.Specifically, a unicondylar procedure generally involves replacement ofportions of either the medial or lateral compartments of the knee joint.For example, in certain patients the surfaces of the proximal tibia anddistal femur will only be worn on either the medial or lateral side.This is often due to injury or wear caused by a certain activity ormovement (e.g., running, walking, etc . . . ). A unicondylar procedurewill see the damaged articulation surfaces (on both the tibia and femur)of the affected compartment being resected and replaced with artificialimplants that essentially recreate the surfaces and allow for the neededarticulation in the joint. Typically, this procedure is performedthrough a single incision located in the skin on either the anterioraspect or side aspect, adjacent the affected compartment of the kneejoint. This type of procedure is a widely utilized technique foraccomplishing the restoration of normal operation to a damaged kneejoint and alleviation of pain in a patient.

Recently, it has become common place to perform two of theaforementioned unicondylar replacement procedures in lieu of a totalknee replacement procedure. Instead of resecting the entire surfaces ofthe proximal tibia and distal femur, as is often done in a totalreplacement procedure, utilizing two unicondylar procedures to replaceboth the medial and lateral compartments allows for some of the bonesurfaces to remain in place and certain of the ligaments and tendons inthe knee to remain intact (e.g., the ACL). However, performing aprocedure in this fashion poses certain difficulties to a surgeon. Forexample, each of the resections of the either the tibia or femur mustdone so that the medial and lateral aspects of each bone are linked soas to allow proper balancing of the joint upon implantation ofreplacement implants. Thus, instruments have been created which allowfor linked resections to be made on either the tibia or femur.Nonetheless, these instruments have their own drawbacks, such as theirinability to conform to differently sized patients and their inabilityto allow precise cutting of the bone.

Therefore, there exists a need for an improved linked resection guidefor use in either a single or double unicondylar procedure.

SUMMARY OF THE INVENTION

A first aspect of the present invention is a tibial resection guide. Theguide includes a first resection guide portion including a first cuttingsurface and a second resection guide portion including a second cuttingsurface. The second resection guide portion is preferably pivotallyconnected to the first resection guide portion, and the first and secondcutting surfaces are preferably positioned with respect to one anotherso as to allow linked cuts to be made on lateral and medial sides of aproximal tibia during a surgical procedure on the knee.

In other embodiments of the first aspect of the present invention thefirst resection guide portion may include a first channel and the secondresection guide portion may include a second channel. The firstresection guide portion may also include a first connection aperture andthe second resection guide portion may also include a second connectionaperture. The tibial resection guide may include a connector pivotallyconnecting the first and second resection guide portions to one another,the connector extending through the first and second connectionapertures. Alternatively, the tibial resection may include anintermediate portion having a first extension, the first extensionextending through the first and second connection apertures. Theintermediate portion may include a second extension adapted to receive anavigation tracker and an intermediate aperture. The tibial resectionguide may include a locking knob extending through the intermediateaperture and the first and second connection apertures. The tibialresection guide may also include a leg extension inserted through one ofthe first or second channels, where the leg extension includes a mainbody, a vertically extending rod, and a leg clamp. The verticallyextending rod may be held in one of the first or second channels witheither a first set screw at least partially extending into the firstchannel or a second set screw at least partially extending into thesecond channel. In a preferred embodiment, the tibial resection guide isadapted for use with an oscillating tip saw. The first and secondresection guide portions may also each include a fixing aperture.

A second aspect of the present invention is a method of resecting atibia during a surgical procedure. In accordance with this aspect, themethod includes the steps of providing a tibial resection guideincluding a first resection guide portion including a first cuttingsurface and a second resection guide portion including a second cuttingsurface, the second resection guide portion being pivotally connected tothe first resection guide portion, vertically positioning the tibialresection guide with respect to a portion of the tibia to be resected,rotating one of the first or second resection guide portions withrespect to the other in order to position the first and second cuttingsurfaces with respect to the portion of the tibia to be resected,engaging a portion of a cutting instrument with one or both of the firstand second cutting surfaces, and resecting the portion of the tibia.

In other embodiments of this second aspect, the method may also includethe steps of fixing the first and second resection guide portions withrespect to the tibia, the step of fixing the first and second resectionguide portions with respect to one another, or the step of fixing one ofthe first or second resection guide portions to a leg extension. Thevertically positioning step may include sliding a vertically extendingrod of the leg extension through a first channel formed in the firstresection guide portion or through a second channel formed in the secondresection guide portion. Likewise, the engaging and resecting steps areperformed with an oscillating tip saw. In any of the mentioned methods,both medial and lateral sides of the tibia may be resected, or just oneof such may be resected.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the subject matter of the presentinvention and the various advantages thereof can be realized byreference to the following detailed description in which reference ismade to the accompanying drawings in which:

FIG. 1 is a front perspective view of a tibial resection guide inaccordance with an embodiment of the present invention.

FIG. 2 is a front view of the tibial resection guide of FIG. 1.

FIG. 3 is a rear view of the tibial resection guide of FIG. 1.

FIG. 4 is a top view of the tibial resection guide of FIG. 1.

FIG. 5 is a bottom perspective view of the tibial resection guide ofFIG. 1.

FIGS. 6A and 6B are exploded views of the tibial resection guide of FIG.1.

FIG. 7 is a perspective view of the tibial resection guide of FIG. 1, inconjunction with a portion of a leg attachment.

FIG. 8 is a view depicting the placement of the tibial resection guideof FIG. 1 during a surgical procedure.

FIG. 9 is a view depicting the insertion of pins through the tibialresection guide of FIG. 1 during a surgical procedure.

FIG. 10 is a view depicting the cutting of a tibia utilizing the tibialresection guide of FIG. 1 during a surgical procedure.

FIG. 11 is a perspective view of a tibial resection guide in accordancewith another embodiment of the present invention.

FIG. 12 is a front perspective view of the tibial resection guide ofFIG. 10, in conjunction with a leg attachment.

FIG. 13 is a rear perspective view of the tibial resection guide of FIG.10, in conjunction with a leg attachment.

DETAILED DESCRIPTION

Referring to the drawings, wherein like reference numerals refer to likeelements, FIGS. 1-10 depict a first embodiment resection guide,designated generally by reference numeral 10. In the embodiment shown,guide 10 is configured for use in resecting the tibia during a single ordouble unicondylar procedure. However, it is to be understood thatcertain of the novel aspects of guide 10 could be employed in otherguides designed for resection of different bones during the same ordifferent procedures. Guide 10 includes three main components whichenable it to operate in the fashion discussed herein, a first resectionguide portion 12, a second resection guide portion 14, and anintermediate portion 16. Each of these components, and the method ofutilizing guide 10, will be discussed more fully below.

First guide portion 12 includes a first body 18 and a second body 20.First body 18 further includes a top surface 22, a bottom surface 24, afront face 26 and a rear face 28 (best shown in FIG. 3). In addition,first body 18 defines a channel 30 (best shown in FIG. 4) extending fromtop surface 22 to bottom surface 24 near where first body 18 connectswith second body 20. A set screw 32 preferably extends through athreaded aperture 34 from front face 26 toward rear face 28, and intochannel 30. Rotation of set screw 32 in one direction or the other actsso as to move a portion of the screw into or out of channel 30. Firstbody 18 also includes one or more fixing apertures 36 extending fromfront face 26 to rear face 28. These apertures are preferably designedto receive pins or the like to facilitate a reinforcing connection ofguide portion 12 to a bone, such as the tibia.

Second body 20 of first guide portion 12 is preferably connected tofirst body 18. Second body 20 includes its own top surface 38 and bottomsurface 40, and one or more connection apertures 42 (best shown in FIG.4) extending through body 20 from the top to bottom surfaces. Inaddition, second body 20 includes a front face 44 and a rear face 46(best shown in FIG. 3), and may include one or more elongate apertures48 a extending through at least a portion of body 20 from the front faceto the rear face, or partially therethrough, which create a series offingers 48 b. In the embodiment shown, second body 20 may be formedintegrally with first body 18 through, for example a molding or millingprocess, or body 20 may be fixably attached to body 18 through the useof, for example, a welding or other well-known attachment process. Incertain embodiments, it is possible for second body 20 to be moveablewith respect to first body 18.

Second guide portion 14 includes several elements similar to those offirst guide portion 12. More particularly, second guide portion 14includes a first body 50 and a second body 52. First body 50 furtherincludes a top surface 54, a bottom surface 56, a front face 58 and arear face 60 (best shown in FIG. 3). In addition, first body 50 definesa channel 62 (best shown in FIG. 4) extending from top surface 54 tobottom surface 56 near where first body 50 connects with second body 52.A set screw 64 preferably extends through a threaded aperture 66 fromfront face 58 toward rear face 60, and into channel 62. Rotation of setscrew 64 in one direction or the other acts so as to move a portion ofthe screw into or out of channel 62. First body 50 also includes one ormore fixing apertures 68 extending from front face 50 to rear face 60.These apertures are preferably designed to receive pins or the like tofacilitate a reinforcing connection of guide portion 14 to a bone, suchas the tibia.

Second body 52 of second guide portion 14 is preferably connected tofirst body 50. Second body 52 includes its own top surface 70 and bottomsurface 72, and one or more connection apertures 74 (best shown in FIG.5) extending through body 52 from the top to bottom surfaces. Inaddition, second body 52 includes a front face 76 and a rear face 78(best shown in FIG. 3), and may include one or more elongate apertures80 a extending through at least a portion of body 52 from the front faceto the rear face, or partially therethrough, which create a series offingers 80 b. As with guide portion 12, second body 52 may be formedintegrally with first body 50 through, for example a molding or millingprocess, or body 52 may be fixable attached to body 50 through the useof, for example, a welding or other well-known attachment process. Onceagain, in certain embodiments, it is possible for second body 52 to bemoveable with respect to first body 50.

Intermediate portion 16 is made up in large part by a triangular-shapedbody 84 having a top surface 86 and a bottom surface 87. A firstextension 88 preferably extends from top surface 86 and includes aconnector 90. A second extension 92 preferably extends from bottomsurface 87. Finally, body 84 includes at least one aperture 94 (bestshown in FIG. 5) extending from top surface 86 to bottom surface 87.Aperture 94 may also extend through a shoulder 96 which extends from topsurface 86 and upward, as is shown in the figures. While body 84 isshown as a triangular shaped body, and such may indeed provide benefitsfor use in accordance with the present invention, it is to be understoodthat body 84 could be any shape. Intermediate portion 16 is preferablydesigned so that second extension 92 extends through one of apertures 74formed in second body 52 of second guide portion 14, while aperture 94,one of apertures 74 formed in second body 52 of second guide portion 14,and one of apertures 42 formed in second body of first guide portion 12all align with one another. This alignment preferably allows for alocking knob 98 to be placed through aperture 94, aperture 74 andaperture 42 to form a pivoting connection between first guide portion 12and second guide portion 14. Thus, first guide portion 12 and secondguide portion 14 may rotate with respect to one another. Locking knob 98is preferably designed so as to lock within shoulder 96 and keep each ofthe components of guide 10 together and pivotally connected, whendesired.

In constructing guide 10, it is noted that the above-discussed elongateapertures 48 a, 80 a, and fingers 48 b, 80 b preferably cooperate withone another. As is best shown in FIGS. 3 and 5-6B, such elementspreferably align so that the above-discussed pivotal connection may berealized. More particularly, fingers 48 b preferably reside withinapertures 80 a, and fingers 80 b preferably reside within apertures 48a, so that an interlaced cooperation of the two portions is formed. Thiscooperation ensures a solid, yet pivotal fit between portions 12 and 14.Of course, it is to be understood that in other embodiments, differentconnection configurations may be utilized. For example, more or lessfingers/apertures may be employed, one of portion 12 or 14 may include acut out for receiving a portion of the other portion, or portion 12 and14 may simply be laid over one another with portions of each aligningwith one another. This latter configuration is shown and discussed inrelation to a second embodiment discussed below.

Each of the components of guide 10 are preferably constructed ofmaterial suitable for use in surgery (e.g., biocompatible materials),and also suitable for use with the cutting apparatus discussed below. Inthis regard, it is noted that the components should be made of arelatively hard and durable material, like stainless steel or the like.It is to be understood that the various components of guide 10 may varyfrom what is shown in the figures. For instance, the components of guide10 may vary in their particular shape depending upon the particular bonebeing resected or the manner in which the guide is being utilized. Allof these variations fall within the scope of the present invention. Inaddition, it is to be understood that certain different components maybe employed in lieu of those shown. For example, instead of screws 32and 64, another retaining means may be utilized, such as spring detentsor the like. Likewise, each of the components of guide 10 may bemanufactured in accordance with well-known processes, such as molding,milling or other processes often employed during the manufacture ofmedical devices and instruments.

In use, guide 10 is preferably first coupled with a leg extension 100,as is shown in FIG. 7. As is more fully shown in FIG. 12, extension 100includes a main body 102, a vertically extending rod 104, and a footclamp 106. Such extensions are known in the art and often employedduring similar procedures performed on the knee joint. Rod 104 may bevertically moveable with respect to main body 102 through sliding withina vertical passage 108 formed within a top portion of body 102. Rod 104may be locked in position by a locking screw 110 or other suitablelocking mechanism which extends into passage 108. Likewise, clamp 106may be moveable, this time horizontally, with respect to main body 102.To facilitate this movement, clamp 106 is provided with a horizontallyextending rod 112 that is capable of sliding within a horizontal passage114 formed within a bottom portion of body 102. Once again, a lockingscrew 116 or other suitable locking mechanism may be provided to lockclamp 106 in place upon the extension of the screw into passage 114.Finally, clamp 106 itself includes two opposed clamping arms 116 and 118which are positionable with respect to one another so as to clamp arounda lower portion of the leg being operated on. In this regard, arms 116and 118 should be capable of being fixably clamped around the leg andcapable of being released upon completion of the surgery or use of guide10. Arm 116 may include a first arm portion 116 a and a second armportion 116 b which are biased with respect to one another. Similarly,arm 118 includes biased first arm portion 118 a and second arm portion118 b. This allows arms 116 and 118 to not only clamp a lower portion ofthe leg, but also to at least partially wrap around same. In order tofacilitate the coupling of guide 10 to leg extension 100, rod 104 ispreferably inserted through either channel 30 or channel 62, the latterbeing shown in FIG. 7. Depending upon which channel 30 or 62 rod 104 isinserted through, the respective guide portion 12 or 14 is clearly fixedwith respect to extension 100. Once rod 104 is inserted in a givenchannel 30 or 62, the corresponding set screw 32 or 64 is tightened tothereby lock guide 10 in place. In this regard, set screw 32 or 64 mustbe initially unscrewed enough to allow the insertion of rod 104 throughthe respective channel 30 or 62. Although extension 100 is shown fullyin connection with a second embodiment guide 10′ (discussed below), suchmay clearly apply to guide 10.

During a double unicondylar procedure, guide 10 is preferably utilizedto make resections of the tibia through two incisions in the region ofthe knee joint. The first step of the surgery is preferably to makeincisions in the anterior portion of the knee joint, so that theproximal portion of the tibia may be accessed. Depending upon thecutting instrument being utilized later in the surgery, the size of theincisions may vary. Preferably, such incisions are made in accordancewith well-known medical practices. With the incisions made, guide 10 andleg extension 100 may be placed upon the leg being operated on, so thatguide lies adjacent or near the incisions. Clamp 106 is placed around adistal portion of the particular leg so as to at least partially affixguide 10 and extension 100 thereto. During this step of initiallyplacing extension 100 on the leg in question, a navigation tracker(shown in FIGS. 8-10 as element 120) may be used in conjunction with anavigation program to aid in the proper placement of the leg extension.Such devices are well-known and widely utilized in the orthopedic field.One example of such is sold under the name “Stryker Navigation System”by the owner of the present application, Howmedica Osteonics Corp. If anavigation system is in fact utilized, clamp 106 may no longer berequired. Thus, use of navigation placement may be done with or withoutclamp 106.

With leg extension 100 in place, guide 10 may be further positioned bythe surgeon or other medical professional in order to properly align itsguide portions 12 and 14 with the bone to be resected. This step isillustrated in FIG. 7. Like the placement of leg extension 100, theplacement of guide 10 may involve the use of a navigation tracker (shownin FIGS. 8-10 as element 122). Tracker 122 is preferably attachedthrough its coupling with connector 90 of intermediate member 16. Such aconnection is known and utilized in many different tooling systems.Tracker 122 is preferably utilized to provide information relating tothe position of guide 10. For example, a surgeon may first move guide 10vertically with respect to extension 100. It is to be understood thatthe aforementioned step of tightened set screws 32 and 64 may beperformed before or after this further positioning of guide 10. Ofcourse, in the case where set screws 32 and 64 have been previouslytightened, such would need to be loosened enough to allow the neededsliding of rod 104 through channel 30 or 62 of guide 10.

The positioning step also preferably includes rotating one of guideportions 12 or 14 into position. As is mentioned above, one of guideportions 12 or 14 will be fixed with respect to leg extension 100depending upon which channel 30 or 62 ultimately accepts rod 104. Forexample, as is shown in FIGS. 8-10, rod 104 of extension 100 is placedthrough channel 30 formed in first body 18 of first guide portion 12.During the attachment of leg extension 100, attention should be paid tohaving first guide portion 12 wind up in its correct position (i.e.,with rear face 28 adjacent or touching the skin of the patient at ornear the proximal portion of the tibia to be resected). This may involverotating extension 100 in one direction or the other with respect to theleg. With first guide portion 12 in place, second guide portion 14 maybe rotated with respect thereto about the pivot connection formed bylocking knob 98 and the cooperation of first guide portion 12, secondguide portion 14 and intermediate portion 16 discussed above. It is tobe understood that once second guide portion 14 is rotated into position(i.e., with rear face 60 adjacent or touching the skin of the patient ator near the proximal portion of the tibia to be resection), locking knob98 could be fully tightened to effectively fix portions 12 and 14 withrespect to one another.

The cooperation between first guide portion 12, second guide portion 14and intermediate portion 16 is such that intermediate portion 16 isfixed with respect to one of portions 12 or 14. Thus, the aforementionedrotation step may include rotating one of portion 12 or 14 with respectto the other portion and intermediate portion 16, or rotating one ofportion 12 or 14 and intermediate portion 16 with respect to the otherportion. However, the inclusion of intermediate portion 16 in guide 10allows for the overall width of the guide to be varied depending uponthe manner which first and second guide portions 12 and 14 are connectedwith intermediate portion 16. For example, in certain embodimentsdifferent apertures of second bodies 20 and 52 may be aligned with oneanother. Extension 92 of intermediate portion 16 could be insertedthrough corresponding aligned apertures, as can locking knob 98, in asimilar fashion to that described above. Hence, the effective width ofguide 10 can be varied depending upon the alignment of first guideportion 12 with respect to second guide portion 14. This provides aguide useful with many differently sized knee joints.

Once guide 10 is placed in the desired position discussed above(preferably confirmed through the use of tracker 122 and to theparticular surgeon's liking), the guide may be pinned to the tibiathrough the utilization of standard bone pins or the like. This is shownin FIG. 9. During this pinning step, the surgeon or other medicalprofessional preferably inserts pins or the like through one or more ofapertures 36 and/or 68 located on guide portions 12 and 14,respectively. Most preferably, at least one pin is inserted through atleast one of apertures 36 and at least one pin is inserted through atleast one of apertures 68. However, any number of pins or other fixingmeans may be utilized. In this fixed state, it is to be understood thatguide portions 12 and 14 of guide 10 are now positioned to allow for thelinked resection of both sides of the proximal tibia. In other words,the structure of guide 10, and the method discussed above, allows forcertain surfaces of guide 10 to be positioned so as to allow for thecorrect cuts to be made on both sides of the proximal tibia.Furthermore, the fact that portions 12 and 14 may ultimately be rotatedwith respect to one another allows the easy positioning of guide 10 formany differently sized patients and knee joints. Similarly, guide 10 maybe positioned to ensure more precise cuts for a particular surgeon. Forinstance, one surgeon may desire guide 10 to be placed as close to theknee joint as possible to better guide his cutting tool, while anothersurgeon may desire some separation of guide 10 and the knee joint. Guide10, and more particularly first and second guide portions 12 and 14 mayeasily be positioned according to the surgeon's liking.

As is best shown in FIG. 10, guide 10 is ultimately used to guide acutting tool to make the necessary resections on the proximal portion ofthe tibia. Although many different types of cutting tools may beutilized, an oscillating tip saw is shown in FIG. 10. The particular sawis sold by Styker Instruments under the name Otis or Stryker PrecisionOscillating Tip Saw. Top surfaces 22 and 54 of first and second guideportions 12 and 14 respectively are shown as being used to guide aportion of this saw in cutting the proximal portion of the tibia. It isto be understood that bottom surfaces 24 and 56 of first and secondguide portions 12 and 14 respectively could also be utilized in guidingthe saw. Of course, the use of the bottom surfaces would require thepositioning of guide 10 such that the surfaces properly align with theportion of the proximal tibia to be resected. In other words, guide 10would most likely need to be moved further vertically should bottomsurface 24 and 56 be utilized.

Once the desired cuts are made on the proximal tibia, the remainingsteps of the double unicondylar procedure may be performed. Thistypically involves similarly preparing the distal portion of the femuron both sides, and ultimately placing implants on the various cutsurfaces created. These implants preferably replicate the originalanatomy and allow for the necessary movement in the knee joint. It is tobe understood that guide 10 could also be utilized in making at leastcertain of the cuts needed in preparing the distal femur. For example,preparation of the distal femur often requires a straight cut, amongother cuts. Since this cut is similar to the straight cuts beingperformed on the proximal tibia, guide 10 could be employed for thisstep in the surgical procedure also. Of course, guide 10 wouldpreferably need to be repositioned in a similar fashion as is describeabove, so that either top surfaces 22 and 54 or bottom surfaces 24 and56 align with the portion desired to be cut on the distal femur.Alternatively, other guide(s) could be utilized to prepare the distalfemur. This would require the removal of at least guide 10, so as toallow the access needed for the surgeon. Once all of the necessary cutshave been made, and the proper implants positioned and affixed, thesurgeon may complete the surgery by closing the incisions.

FIGS. 11-13 depict another embodiment tibial resection guide, designatedgenerally by reference numeral 10′. In fact, because of the similaritiesbetween guide 10 and guide 10′, like elements of guide 10′ have beenlabeled with similar references numerals to that of guide 10 with aprime indicator. More particularly, guide 10′ includes two maincomponents which enable it to operate in a fashion nearly identical tothat of guide 10, a first resection guide portion 12′ and a secondresection guide portion 14′. Each of these components will be discussedmore fully below.

First guide portion 12′ includes a first body 18′ and a second body 20′.First body 18′ further includes a top surface 22′, a bottom surface 24′,a front face 26′ and a rear face 28′. In addition, first body 18′defines a channel 30′ extending from top surface 22′ to bottom surface24′ near where first body 18′ connects with second body 20′. A set screw32′ (not shown) preferably extends through a threaded aperture 34′ fromfront face 26′ toward rear face 28′, and into channel 30′. Rotation ofset screw 32′ in one direction or the other acts so as to move a portionof the screw into or out of channel 30′. First body 18′ also includesone or more fixing apertures 36′ extending from front face 26′ to rearface 28′. These apertures are preferably designed to receive pins or thelike to facilitate a reinforcing connection of guide portion 12′ to abone, such as the tibia.

Second body 20′ of first guide portion 12′ is preferably connected tofirst body 18′. Second body 20′ includes its own top surface 38′ andbottom surface 40′, and one or more connection apertures 42′ extendingthrough body 20′ from the top to bottom surfaces. In addition, secondbody 20′ includes a front face 44′ and a rear face 46′. In the secondembodiment, second body 20′ may be formed integrally with first body 18′through, for example a molding or milling process, or body 20′ may befixable attached to body 18′ through the use of, for example, a weldingor other well-known attachment process. In certain embodiments, it ispossible for second body 20′ to be moveable with respect to first body18′.

Second guide portion 14′ includes several elements similar to those offirst guide portion 12′. More particularly, second guide portion 14′includes a first body 50′ and a second body 52′. First body 50′ furtherincludes a top surface 54′, a bottom surface 56′, a front face 58′ and arear face 60′. In addition, first body 50′ defines a channel 62′extending from top surface 54′ to bottom surface 56′ near where firstbody 50′ connects with second body 52′. A set screw 64′ preferablyextends through a threaded aperture 66′ from front face 58′ toward rearface 60′, and into channel 62′. Rotation of set screw 64′ in onedirection or the other acts so as to move a portion of the screw into orout of channel 62′. First body 50′ also includes one or more connectionapertures 68′ extending from front face 50′ to rear face 60′. Theseapertures are preferably designed to receive pins or the like tofacilitate a reinforcing connection of guide portion 14′ to a bone, suchas the tibia.

Second body 52′ of second guide portion 14′ is preferably connected tofirst body 50′. Second body 52′ includes its own top surface 70′ andbottom surface 72′, and one or more connection apertures 74′ extendingthrough body 52′ from the top to bottom surfaces. In addition, secondbody 52′ includes a front face 76′ and a rear face 78′. As with guideportion 12′, second body 52′ may be formed integrally with first body50′ through, for example a molding or milling process, or body 52′ maybe fixable attached to body 50′ through the use of, for example, awelding or other well-known attachment process. Once again, in certainembodiments, it is possible for second body 52′ to be moveable withrespect to first body 50′.

However, rather than an element like intermediate portion 16 of guide10, guide 10′ exhibits a design in which first guide portion 12′ isdirectly connected to second guide portion 14′. Preferably, one ofapertures 74′ of second guide portion 14′ is capable of extending overand aligning with one of apertures 42′ of first guide portion 12′.Thereafter, a connector 88′ (similar in nature to locking knob 88 ofguide 10) may be inserted through the aligned apertures to pivotallylock first and second guide portions 12′ and 14′ together. Thisconnector also preferably allows for a navigation tracker (like thosediscussed above) to be attached to guide 10′. In fact, the particularconnector design shown is the subject of commonly owned U.S. PatentApplication Publication No. 2006/0089641, the disclosure of which ishereby incorporated by reference herein. It is to be understood that theoutside aperture 74′ of second guide portion 14′ is essentially designedto lie over a thinned portion of second body 20′. However, additionalapertures 74′ could lie over similarly thinned sections, therebyfacilitating the connection of second guide portion 14′ to first guideportion 12′ through different aligned apertures.

The use of guide 10′ is essentially the same as that of guide 10.However, the mode of connecting first and second guide portions 12′ and14′, without an intermediate portion, makes both truly pivotable withrespect to only one another. In addition, FIGS. 11-13 depict apositioning arm 130′ affixed to second guide portion 14′. Thispositioning arm may aid the surgeon or other medical professional inproperly aligning guide 10′ with respect to the bone to be resected.While only shown in connection with guide 10′, it is to be understoodthat positioning arm 130′ may be utilized in conjunction with guide 10.

Like with guide 10, each of the components of guide 10′ are preferablyconstructed of material suitable for use in surgery (e.g., biocompatiblematerials), and also suitable for use with the cutting apparatusdiscussed below. In this regard, it is noted that the components shouldbe made of a relatively hard and durable material, like stainless steelor the like. It is to be understood that the various components of guide10 may vary from what is shown in the figures. For instance, thecomponents of guide 10′ may vary in their particular shape dependingupon the particular bone being resected or the manner in which the guideis being utilized. All of these variations fall within the scope of thepresent invention. In addition, it is to be understood that certaindifferent components may be employed in lieu of those shown. Forexample, instead of screws 32′ and 64′, another retaining means may beutilized, such as spring detents or the like. Likewise, each of thecomponents of guide 10′ may be manufactured in accordance withwell-known processes, such as molding, milling or other processes oftenemployed during the manufacture of medical devices and instruments.

Finally, it is noted that although both guides 10 and 10′ have beendiscussed in relation to a method of performing a double uniconylarprocedure, either guide may be similarly utilized in performing atraditional single unicondylar procedure. Obviously, such a procedurewould only require a single incision and the guiding of a tool by eitherthe first or second guide portions of either guide 10 or 10′. It is tobe understood that guide 10 or 10′ can be set up with both or just oneof its first and/or second guide portions being attached to the onebeing utilized in guiding the cuts. Thus, a surgeon may only utilize asingle guide portion in performing a single unicondylar procedure.Nonetheless, it is also possible to have both guide portions present incase it is determined, by the surgeon, that a double unicondylarprocedure is required. In this regard, the initially unused guideportion could simply be pivoted out position during non-use and pivotedinto position if needed.

Although the invention herein has been described with reference toparticular embodiments, it is to be understood that these embodimentsare merely illustrative of the principles and applications of thepresent invention. It is therefore to be understood that numerousmodifications may be made to the illustrative embodiments and that otherarrangements may be devised without departing from the spirit and scopeof the present invention as defined by the appended claims.

1. A tibial resection guide comprising: a first resection guide portionincluding a first cutting surface; and a second resection guide portionincluding a second cutting surface, the second resection guide portionbeing pivotally connected to the first resection guide portion, whereinthe first and second cutting surfaces are positioned with respect to oneanother so as to allow linked cuts to be made on lateral and medialsides of a proximal tibia during a surgical procedure on the knee. 2.The tibial resection guide of claim 1, wherein the first resection guideportion includes a first channel and the second resection guide portionincludes a second channel.
 3. The tibial resection guide of claim 2,wherein the first resection guide portion includes a first connectionaperture and the second resection guide portion includes a secondconnection aperture.
 4. The tibial resection guide of claim 3, furthercomprising a connector pivotally connecting the first and secondresection guide portions to one another, the connector extending throughthe first and second connection apertures.
 5. The tibial resection guideof claim 3, further comprising an intermediate portion including a firstextension, the first extension extending through the first and secondconnection apertures.
 6. The tibial resection guide of claim 5, whereinthe intermediate portion includes a second extension adapted to receivea navigation tracker and an intermediate aperture.
 7. The tibialresection guide of claim 6, further comprising a locking knob extendingthrough the intermediate aperture and the first and second connectionapertures.
 8. The tibial resection guide of claim 7, further comprisinga navigation tracker attached to the second extension.
 9. The tibialresection guide of claim 2, further comprising a leg extension insertedthrough one of the first or second channels.
 10. The tibial resectionguide of claim 9, wherein the leg extension includes a main body, avertically extending rod, and a leg clamp.
 11. The tibial resectionguide of claim 10, wherein the vertically extending rod is held in oneof the first or second channels with either a first set screw at leastpartially extending into the first channel or a second set screw atleast partially extending into the second channel.
 12. The tibialresection guide of claim 1, wherein the guide is adapted for use with anoscillating tip saw.
 13. The tibial resection guide of claim 1, whereinthe first and second resection guide portions each include a fixingaperture.
 14. The tibial resection guide of claim 1, wherein the firstresection guide portion includes a plurality of elongate apertures andfingers interlaced with a plurality of elongate apertures and fingers ofthe second resection guide portion.
 15. A method of resecting a tibiaduring a surgical procedure, the method comprising the steps of:providing a tibial resection guide including a first resection guideportion including a first cutting surface and a second resection guideportion including a second cutting surface, the second resection guideportion being pivotally connected to the first resection guide portion;vertically positioning the tibial resection guide with respect to aportion of the tibia to be resected; rotating one of the first or secondresection guide portions with respect to the other in order to positionthe first and second cutting surfaces with respect to the portion of thetibia to be resected; engaging a portion of a cutting instrument withone or both of the first and second cutting surfaces; and resecting theportion of the tibia.
 16. The method according to claim 15, furthercomprising the step of fixing the first and second resection guideportions with respect to the tibia.
 17. The method according to claim15, further comprising the step of fixing the first and second resectionguide portions with respect to one another.
 18. The method according toclaim 15, further comprising the step of fixing one of the first orsecond resection guide portions to a leg extension.
 19. The methodaccording to claim 18, wherein the vertically positioning step includessliding a vertically extending rod of the leg extension through a firstchannel formed in the first resection guide portion or through a secondchannel formed in the second resection guide portion.
 20. The methodaccording to claim 15, wherein the engaging and resecting steps areperformed with an oscillating tip saw.
 21. The method according to claim15, wherein both medial and lateral sides of the tibia are resected.